Department of Surgery, Stanford University Medical Center, Stanford, California, USA.
J Surg Oncol. 2012 Sep 15;106(4):381-5. doi: 10.1002/jso.23091. Epub 2012 Mar 6.
Papilloma is the most common finding associated with pathologic nipple discharge. In the absence of breast imaging abnormalities, the incidence of occult malignancy is <3%.
To determine the predictive value of nipple discharge cytology in conjunction with breast imaging.
Retrospective review of 160 charts; inclusion criteria of clinically pathologic nipple discharge, subsequent excisional biopsy, and absence of palpable abnormalities. Nipple discharge cytology categorized as negative, atypical, suspicious, and papillary. Breast imaging was analyzed. Preoperative tests were correlated to final surgical pathology.
89 patients identified. Sixty-five had positive cytology, with a false positive rate of 32.3%. They were associated with papillomas in 52%, benign non-papillary in 33% and malignant lesions in 9% of cases. Nipple discharge cytology was positive in 69.6% of papillomas and 92% of atypical/malignant lesions; 30% had abnormal breast imaging and positive cytology. Nipple discharge cytology had a sensitivity of 74.5%, specificity of 30%, and positive predictive value of 68%. The positive predictive value increased to 85% with associated abnormal breast imaging.
Nipple discharge cytology is useful in evaluating pathologic discharge. However, negative cytology with negative imaging is not enough to avoid surgery in cases of suspicious clinical presentation.
乳突瘤是与病理性乳头溢液最常见的相关发现。在没有乳房影像学异常的情况下，隐匿性恶性肿瘤的发病率<3%。
确定乳头溢液细胞学与乳房影像学检查相结合的预测价值。
回顾性分析了 160 份图表；纳入标准为临床病理乳头溢液、随后的切除活检以及无可触及的异常。乳头溢液细胞学分类为阴性、非典型、可疑和乳突状。分析乳房影像学。术前检查与最终手术病理相关。
确定了 89 名患者。65 名患者的细胞学呈阳性，假阳性率为 32.3%。它们与 52%的乳突瘤、33%的良性非乳突瘤和 9%的恶性病变有关。乳头溢液细胞学在 69.6%的乳突瘤和 92%的非典型/恶性病变中呈阳性；30%的患者乳房影像学异常和细胞学阳性。乳头溢液细胞学的敏感性为 74.5%，特异性为 30%，阳性预测值为 68%。如果伴有异常的乳房影像学，阳性预测值会增加到 85%。
乳头溢液细胞学在评估病理性溢液方面是有用的。然而，在可疑临床表现的情况下，阴性的细胞学和阴性的影像学检查并不能足以避免手术。
